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Gayawan E, Cameron E, Okitika T, Egbon OA, Gething P. A situational assessment of treatments received for childhood diarrhea in the Federal Republic of Nigeria. PLoS One 2024; 19:e0303963. [PMID: 38776302 PMCID: PMC11111079 DOI: 10.1371/journal.pone.0303963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/04/2024] [Indexed: 05/24/2024] Open
Abstract
We assess progress towards improved case management of childhood diarrhea in Nigeria over a period of targeted health systems reform from 2013 to 2018. Individual and community data from three Demographic and Health Survey rounds are leveraged in a geospatial model designed for stratified estimation by venue of treatment seeking and State. Our analysis reveals a highly regionalised health system undergoing rapid change. Nationally, there have been substantial increases in the proportion of children under 5 years old with diarrhea receiving the recommended oral rehydration therapy after seeking treatment at either a health clinic (0.57 [0.44-0.69; 95% CI] in 2008; 0.70 [0.54-0.83] in 2018) or chemist/pharmacy (0.28 [0.17-0.42] in 2008; 0.48 [0.31-0.64] in 2018). Yet State-level variations in venue attendance and performance by venue have conspired to hold the overall proportion receiving this potentially life-saving therapy (0.45 [0.35-0.55] in 2018) to well-below ideal coverage levels. High performing states that have demonstrated significant improvements include Kano, Jigawa and Borno, while under-performing states that have suffered declines in coverage include Kaduna and Taraba. The use of antibiotics is not recommended for mild cases of childhood diarrhea yet remains concerningly high nationally (0.27 [0.19-0.36] in 2018) with negligible variation between venues. Antibiotic use rates are particularly high in Enugu, Kaduna, Taraba, Kano, Niger and Kebbi, yet welcome reductions were identified in Jigawa, Adamawa and Osun. These results support the conclusions of previous studies and build the strength of evidence that urgent action is needed throughout the multi-tiered health system to improve the quality and equity of care for common childhood illnesses in Nigeria.
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Affiliation(s)
- Ezra Gayawan
- Department of Statistics, Federal University of Technology, Akure, Nigeria
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Ewan Cameron
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Tolu Okitika
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Osafu Augustine Egbon
- Department of Statistics, Federal University of Technology, Akure, Nigeria
- Department of Statistics, Federal University of São Carlos, São Carlos, Brazil
| | - Peter Gething
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
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Seboka BT, Mamo TT, Mekonnen T. Identifying geographical inequalities of maternal care utilization in Ethiopia: a Spatio-temporal analysis from 2005 to 2019. BMC Health Serv Res 2022; 22:1455. [PMID: 36451235 PMCID: PMC9714149 DOI: 10.1186/s12913-022-08850-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Inequalities in maternal care utilization pose a significant threat to maternal health programs. This study aimed to describe and explain the spatial variation in maternal care utilization among pregnant women in Ethiopia. Accordingly, this study focuses on identifying hotspots of underutilization and mapping maternal care utilization, as well as identifying predictors of spatial clustering in maternal care utilization. METHODS We evaluated three key indicators of maternal care utilization: pregnant women who received no antenatal care (ANC) service from a skilled provider, utilization of four or more ANC visits, and births attended in a health facility, based the Ethiopian National Demographic and Health Survey (EDHS5) to 2019. Spatial autocorrelation analysis was used to measure whether maternal care utilization was dispersed, clustered, or randomly distributed in the study area. Getis-Ord Gi statistics examined how Spatio-temporal variations differed through the study location and ordinary Kriging interpolation predicted maternal care utilization in the unsampled areas. Ordinary least squares (OLS) regression was used to identify predictors of geographic variation, and geographically weighted regression (GWR) examined the spatial variability relationships between maternal care utilization and selected predictors. RESULT A total of 26,702 pregnant women were included, maternal care utilization varies geographically across surveys. Overall, statistically significant low maternal care utilization hotspots were identified in the Somali region. Low hotspot areas were also identified in northern Ethiopia, stretching into the Amhara, Afar, and Beneshangul-Gumuz regions; and the southern part of Ethiopia and the Gambella region. Spatial regression analysis revealed that geographical variations in maternal care utilization indicators were commonly explained by the number of under-five children, the wealth index, and media access. In addition, the mother's educational status significantly explained pregnant women, received no ANC service and utilized ANC service four or more times. Whereas, the age of a mother at first birth was a spatial predictor of pregnant who received no ANC service from a skilled provider. CONCLUSION In Ethiopia, it is vital to plan to combat maternal care inequalities in a manner suitable for the district-specific variations. Predictors of geographical variation identified during spatial regression analysis can inform efforts to achieve geographical equity in maternal care utilization.
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Affiliation(s)
- Binyam Tariku Seboka
- grid.472268.d0000 0004 1762 2666School of Public Health, Dilla University, Dilla, Ethiopia
| | - Tizalegn Tesfaye Mamo
- grid.472268.d0000 0004 1762 2666School of Public Health, Dilla University, Dilla, Ethiopia
| | - Tensae Mekonnen
- grid.1029.a0000 0000 9939 5719Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2751, Australia
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Alemu SM, Tura AK, do Amaral GSG, Moughalian C, Weitkamp G, Stekelenburg J, Biesma R. How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review. J Glob Health 2022; 12:04066. [PMID: 35939400 PMCID: PMC9359463 DOI: 10.7189/jogh.12.04066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Sub-Saharan Africa (SSA) has the world's highest maternal and neonatal morbidity and mortality and has shown the slowest progress in reducing them. In addition, there is substantial inequality in terms of maternal and neonatal morbidity and mortality in the region. Geospatial studies can help prioritize scarce resources by pinpointing priority areas for implementation. This systematic review was conducted to explore the application of geospatial analysis to maternal and neonatal morbidity and mortality in SSA. Methods A systematic search of PubMed, SCOPUS, EMBASE, and Web of Science databases was performed. All observational and qualitative studies that reported on maternal or neonatal health outcomes were included if they used a spatial analysis technique and were conducted in a SSA country. After removing duplicates, two reviewers independently reviewed each study's abstract and full text for inclusion. Furthermore, the quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Finally, due to the heterogeneity of studies, narrative synthesis was used to summarize the main findings, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was strictly followed to report the review results. A total of 56 studies were included in the review. Results We found that geospatial analysis was used to identify inequalities in maternal and neonatal morbidity, mortality, and health care utilization and to identify gaps in the availability and geographic accessibility of maternal health facilities. In addition, we identified a few studies that used geospatial analysis for modelling intervention areas. We also detected challenges and shortcomings, such as unrealistic assumptions used by geospatial models and a shortage of reliable, up-to-date, small-scale georeferenced data. Conclusions The use of geospatial analysis for maternal and neonatal health in SSA is still limited, and more detailed spatial data are required to exploit the potential of geospatial technologies fully.
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Affiliation(s)
- Sisay Mulugeta Alemu
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, Groningen, the Netherlands
| | - Abera Kenay Tura
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Gabriel S Gurgel do Amaral
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Catherine Moughalian
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerd Weitkamp
- Department of Cultural Geography, Faculty of Spatial Sciences, University of Groningen, Groningen, the Netherlands
| | - Jelle Stekelenburg
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, Groningen, the Netherlands.,Department Obstetrics & Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - Regien Biesma
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, Groningen, the Netherlands
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Factors Associated with Underutilization of Maternity Health Care Cascade in Mozambique: Analysis of the 2015 National Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137861. [PMID: 35805519 PMCID: PMC9265725 DOI: 10.3390/ijerph19137861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023]
Abstract
Maternity health care services utilization determines maternal and neonate outcomes. Evidence about factors associated with composite non-utilization of four or more antenatal consultations and intrapartum health care services is needed in Mozambique. This study uses data from the 2015 nationwide Mozambique’s Malaria, Immunization and HIV Indicators Survey. At selected representative households, women (n = 2629) with child aged up to 3 years answered a standardized structured questionnaire. Adjusted binary logistic regression assessed associations between women-child pairs characteristics and non-utilization of maternity health care. Seventy five percent (95% confidence interval (CI) = 71.8–77.7%) of women missed a health care cascade step during their last pregnancy. Higher education (adjusted odds ratio (AOR) = 0.65; 95% CI = 0.46–0.91), lowest wealth (AOR = 2.1; 95% CI = 1.2–3.7), rural residency (AOR = 1.5; 95% CI = 1.1–2.2), living distant from health facility (AOR = 1.5; 95% CI = 1.1–1.9) and unknown HIV status (AOR = 1.9; 95% CI = 1.4–2.7) were factors associated with non-utilization of the maternity health care cascade. The study highlights that, by 2015, recommended maternity health care cascade utilization did not cover 7 out of 10 pregnant women in Mozambique. Unfavorable sociodemographic and economic factors increase the relative odds for women not being covered by the maternity health care cascade.
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Health facility delivery among women of reproductive age in Nigeria: Does age at first birth matter? PLoS One 2021; 16:e0259250. [PMID: 34735506 PMCID: PMC8568178 DOI: 10.1371/journal.pone.0259250] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 10/16/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND High maternal mortality ratio in sub-Saharan Africa (SSA) has been linked to inadequate medical care for pregnant women due to limited health facility delivery utilization. Thus, this study, examined the association between age at first childbirth and health facility delivery among women of reproductive age in Nigeria. METHODS The study used the most recent secondary dataset from Nigeria's Demographic and Health Survey (NDHS) conducted in 2018. Only women aged15-49 were considered for the study (N = 34,193). Bi-variate and multivariable logistic regression models were used to examine the association between age at first birth and place of delivery. The results were presented as crude odds ratios and adjusted odds ratios (aOR) with corresponding 95% confidence intervals (CIs). Statistical significance was set at p<0.05. RESULTS The results showed that the prevalence of health facility deliveries was 41% in Nigeria. Women who had their first birth below age 20 [aOR = 0.82; 95%(CI = 0.74-0.90)] were less likely to give birth at health facilities compared to those who had their first birth at age 20 and above. CONCLUSION Our findings suggest the need to design interventions that will encourage women of reproductive age in Nigeria who are younger than 20 years to give birth in health facilities to avoid the risks of maternal complications associated with home delivery. Such interventions should include male involvement in antenatal care visits and the education of both partners and young women on the importance of health facility delivery.
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Spatial location, temperature and rainfall diversity affect the double burden of malnutrition among women in Kenya. SSM Popul Health 2021; 16:100939. [PMID: 34660880 PMCID: PMC8503666 DOI: 10.1016/j.ssmph.2021.100939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 11/22/2022] Open
Abstract
Studies have looked into how environmental and climate covariates affect under-and over-nutrition, but little is known about the spatial distribution of different forms of malnutrition in Kenya and whether there are locations that suffer from double-burden of malnutrition. This research quantifies spatial variations and estimates how climatic and environmental factors affect under-and over-nutrition among women in Kenya. This enables us to determine if the patterns in which these factors affect the malnutrition indicators are similar and whether there are overlaps in the spatial distributions. The study used data from the Demographic and Health Survey, which included cross-sectional data on malnutrition indicators as well as some climate and environmental variables. A multicategorical response variable that classified the women into one of four nutritional classes was generated from the body mass index (BMI) of the women, and a Bayesian geoadditive regression model with an estimate based on the Markov chain Monte Carlo simulation technique was adopted. Findings show that women in Turkana, Samburu, Isiolo, Baringo, Garissa, and West Pokot counties are more likely to be underweight than women in other counties while being overweight is prevalent in Kirinyag'a and Kitui counties. Obesity is prevalent in Kirinyag'a, Lamu, Kiambu, Murang'a, and Taita Taveta counties. The study further shows that as mean temperature and precipitation increase, the likelihood of being underweight reduces. The chances of being underweight are lower among literate women [OR: 0.614; 95% CrI: 0.513,0.739], married women [OR: 0.702; 95% CrI: 0.608,0.819] and those from rich households [OR: 0.617; 95% CrI: 0.489,0.772], which is not the case for overweight and obesity. The generated spatial maps identify hot spots of the double burden of malnutrition that can assist the government and donor agencies in channeling resources efficiently. Low- and middle-income countries have been experiencing double burden of malnutrition. The generated spatial maps identify hot spots of the double burden of malnutrition. Carefully thought-out policy plans are required to curb the challenges of the double burden of malnutrition. Burden of undernutrition has decreased but the cost of being overweight or obese is increasing among women.
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Adebayo SB, Gayawan E. Exploring Spatial Variations, Trend and Effect of Exposure to Media as an Enhancer to Uptake of Modern Family Planning Methods: Evidence from 2003 to 2018 Nigeria Demographic Health Survey. SPATIAL DEMOGRAPHY 2021. [DOI: 10.1007/s40980-021-00080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dankwah E, Feng C, Kirychuck S, Zeng W, Lepnurm R, Farag M. Assessing the contextual effect of community in the utilization of postnatal care services in Ghana. BMC Health Serv Res 2021; 21:40. [PMID: 33413362 PMCID: PMC7792027 DOI: 10.1186/s12913-020-06028-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequalities in the use of postnatal care services (PNC) in Ghana have been linked to poor maternal and neonatal health outcomes. This has ignited a genuine concern that PNC interventions with a focus on influencing solely individual-level risk factors do not achieve the desired results. This study aimed to examine the community-level effect on the utilization of postnatal care services. Specifically, the research explored clusters of non-utilization of PNC services as well as the effect of community-level factors on the utilization of PNC services, with the aim of informing equity-oriented policies and initiatives. METHODS The 2014 Ghana Demographic and Health Survey GDHS dataset was used in this study. Two statistical methods were used to analyze the data; spatial scan statistics were used to identify hotspots of non-use of PNC services and second two-level mixed logistic regression modeling was used to determine community-level factors associated with PNC services usage. RESULTS This study found non-use of PNC services to be especially concentrated among communities in the Northern region of Ghana. Also, the analyses revealed that community poverty level, as well as community secondary or higher education level, were significantly associated with the utilization of PNC services, independent of individual-level factors. In fact, this study identified that a woman dwelling in a community with a higher concentration of poor women is less likely to utilize of PNC services than those living in communities with a lower concentration of poor women (Adjusted odds ratio (AOR) = 0.60, 95%CI: 0.44-0.81). Finally, 24.0% of the heterogeneity in PNC services utilization was attributable to unobserved community variability. CONCLUSION The findings of this study indicate that community-level factors have an influence on women's health-seeking behavior. Community-level factors should be taken into consideration for planning and resource allocation purposes to reduce maternal health inequities. Also, high-risk communities of non-use of obstetric services were identified in this study which highlights the need to formulate community-specific strategies that can substantially shift post-natal use in a direction leading to universal coverage.
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Affiliation(s)
- Emmanuel Dankwah
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Cindy Feng
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.,Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Centre for Clinical Research, 5790 University Ave., Halifax, NS, B3H 1V7, Canada
| | - Shelley Kirychuck
- Department of Medicine, College of Medicine, Canadian Centre for Health and Safety in Agriculture (CCHSA), 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Wu Zeng
- School of Nursing & Health Studies, Georgetown University, 3700 Reservoir Rd, Washington, DC, 20007, USA
| | - Rein Lepnurm
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Marwa Farag
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada. .,School of Public Administration and Development Economics, Doha Institute for Graduate Studies, Al Tarfa Street, Zone 70, Doha, Qatar.
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Does where mothers live matter? Regional variations in factors influencing place of child delivery in Nigeria. J Biosoc Sci 2020; 54:163-183. [PMID: 33303042 DOI: 10.1017/s0021932020000747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Utilization of health care facilities for child delivery is associated with improved maternal and neonatal outcomes, but less than half of mothers use these for child delivery in Nigeria. This study investigated the factors associated with facility delivery in Nigeria, and their variation between the Northern and Southern parts of the country - two regions with distinct socio-cultural make-ups. The study included 33,924 mothers aged 15-49 who had given birth in the last 5 years preceding the 2018 Nigeria Demographic and Health Survey. Overall, higher age, being educated, being a Christian, being an urban resident, being exposed to mass media, making joint decisions with partner on health care, beginning antenatal visits in the first trimester and attending antenatal clinics frequently were found to be associated with improved use of a health care facility for child delivery. An average mother in Northern Nigeria had a 38% chance of having a facility-based delivery, whereas the likelihood in the South was 76%. When other factors were adjusted for, age and listening to the radio were significant predictors of facility-based delivery in the South but not in the North. In the North, Christians were more likely than Muslims to have a facility-based delivery, but the reverse was true in the South. Rural women in the South had a 16% greater chance of having a facility-based delivery than urban women in the North. The study results suggest that there is inequality in access to health care facilities in Nigeria, and the differences in the socio-cultural make-up of the two regions suggest that uniform intervention programmes may not yield similar results across the regions. The findings give credence to, and expand on, the Cosmopolitan-Success and Conservative-Failure Hypothesis.
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Muluneh AG, Animut Y, Ayele TA. Spatial clustering and determinants of home birth after at least one antenatal care visit in Ethiopia: Ethiopian demographic and health survey 2016 perspective. BMC Pregnancy Childbirth 2020; 20:97. [PMID: 32046677 PMCID: PMC7014695 DOI: 10.1186/s12884-020-2793-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND All pregnancies are at risk and have to be attended by skilled professionals. In Ethiopia however nearly half (45.7%) of the women were giving birth at home after antenatal care (ANC) visits in which skilled professionals were not available. Therefore, the aim of this study was to assess spatial clustering and the determinant factors of home delivery after antenatal care visits in Ethiopia. METHODS A case control study was conducted on 2110 mothers who gave birth at home after ANC (cases), and 2510 mothers who gave birth at health institutions after attending ANC (controls), based on EDHS 2016 data. As per the recommendations of the DHS program, we weighed the data before analysis. ArcGIS 10.3 was used to show spatial pattern and SaTScan™ 9.4 to identify significant clusters. Stata 14 was used for data cleaning, weighing, and the analysis of the determinant factors. Bi variable and multi variable multilevel mixed effect logistic regression was fitted. Finally, the Log-likelihood ratio (LLR) and Relative risk with p-value of spatial scan statistics and AOR with 95% CI for significant determinant factors were reported. RESULTS Home delivery after ANC was spatially clustered in Ethiopia (Moran's Index = 0.91, p-value< 0.01). Attending, 1-3 ANC visits (AOR = 1.41, 95%CI: 1.17-1.71), no information about birth preparedness plan (AOR = 2.21, 95%CI: 1.83-2.69), pregnancies wanted later (AOR = 1.55, 95%CI: 1.20, 2.06), not having health insurance (AOR = 2.16, 95% CI: 1.29, 3.62), Muslim (AOR = 1.57, 95% CI: 1.13, 2.19) and protestant (AOR = 1.72, 95%CI: 1.16, 2.42) religions were positively associated with home delivery; While being rich (AOR = 0.42, 95%CI: 0.32-0.54), middle wealth index (AOR = O.66, 95%CI: 0.51, 0.86), primary education (AOR = 0.45, 95%CI: 0.36-0.55), secondary education (AOR = 0.11, 95%CI: 0.07-0.16), above secondary education (AOR = 0.06, 95%CI: 0.03-0.11) were negatively associated. CONCLUSIONS Home delivery after ANC follow ups was spatially clustered. Socio-demographic, health service and pregnancy related factors determined the prevalence of home delivery after antenatal care visits. Strengthening women's education, ANC visit, giving more information about birth preparedness plan, and improving family wealth are vital to reduce home delivery after antenatal care visits.
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Affiliation(s)
- Atalay Goshu Muluneh
- Department of Public Health Officer, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yaregal Animut
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Gondar University Dabat research center, Gondar, Ethiopia
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Ag Ahmed MA, Hamelin-Brabant L, Gagnon MP. Nomads' perceptions of quality, accessibility, and affordability of health services as determinants of using skilled birth attendants in Gossi, Mali. Midwifery 2019; 79:102556. [PMID: 31634758 DOI: 10.1016/j.midw.2019.102556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/01/2019] [Accepted: 10/08/2019] [Indexed: 11/20/2022]
Abstract
AIM More than half of all maternal deaths worldwide occur in sub-Saharan Africa (SSA). For nomadic pastoralists (30 to 60 million) in SSA, the risk of maternal death is very high because of the low proportion of assisted deliveries in the areas where they live. The objective of this research was to understand the determinants of using skilled birth attendants in relation to the perceptions of quality, geographic accessibility, and financial affordability of health services by nomadic women. METHODS We used a qualitative research design, inspired by ethnography. Research was conducted in the commune of Gossi (Mali), where 90% of the population is nomadic. The study population consisted of 26 nomadic women living in their camps. Saturation and diversification guided sampling. Semi-structured individual interviews and non-participant observation enabled concomitant data collection. Thematic content analysis was performed using QDA Miner software. RESULTS Our results show that only 10 women used assisted childbirth for their last delivery. These women thought that health workers were competent and well trained, and they liked the fact that these workers were recruited locally. Similarly, these 10 women deemed the health workers' attitude acceptable and appreciated their availability. In contrast, the majority of participants (16 women) were prevented or discouraged from using skill birth attendants. Some of them did not use them because they were afraid of being undressed, of giving birth on a table, and especially of male staff. They also said that they did not have access to information about health services. In addition, respondents considered health services very difficult to access due to distances, unavailable means of transportation, and costs perceived as being expensive. CONCLUSION Our results identify several determinants of the use or non-use of skilled birth attendants by nomadic women in relation to the context and way of life. In addition, our findings call for future research to better understand these determinants and to deepen, refine, and test emerging strategies that seem potentially hopeful with respect to facilitating the use of skilled birth attendance in SSA.
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Affiliation(s)
- Mohamed Ali Ag Ahmed
- Université Laval, 1050 Avenue de la Médecine, room 3696, Québec, Québec G1V 0A6, Canada.
| | - Louise Hamelin-Brabant
- Faculty of Nursing Sciences, Université Laval, 1050 Avenue de la Médecine, room 3447, Québec, Québec G1V 0A6, Canada.
| | - Marie-Pierre Gagnon
- Faculty of Nursing Sciences, Université Laval, 1050 Avenue de la Médecine, room 1426, Québec, Québec G1V 0A6, Canada.
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Gayawan E, Adarabioyo MI, Okewole DM, Fashoto SG, Ukaegbu JC. Geographical variations in infant and child mortality in West Africa: a geo-additive discrete-time survival modelling. GENUS 2016. [DOI: 10.1186/s41118-016-0009-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Analyzing Spatial Distribution of Antenatal Care Utilization in West Africa Using a Geo-additive Zero-Inflated Count Model. SPATIAL DEMOGRAPHY 2016. [DOI: 10.1007/s40980-016-0027-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sarmiento I, Zuluaga G, Andersson N. Traditional medicine used in childbirth and for childhood diarrhoea in Nigeria's Cross River State: interviews with traditional practitioners and a statewide cross-sectional study. BMJ Open 2016; 6:e010417. [PMID: 27094939 PMCID: PMC4838688 DOI: 10.1136/bmjopen-2015-010417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Examine factors associated with use of traditional medicine during childbirth and in management of childhood diarrhoea. DESIGN Cross-sectional cluster survey, household interviews in a stratified last stage random sample of 90 census enumeration areas; unstructured interviews with traditional doctors. SETTING Oil-rich Cross River State in south-eastern Nigeria has 3.5 million residents, most of whom depend on a subsistence agriculture economy. PARTICIPANTS 8089 women aged 15-49 years in 7685 households reported on the health of 11,305 children aged 0-36 months in July-August 2011. PRIMARY AND SECONDARY OUTCOME MEASURES Traditional medicine used at childbirth and for management of childhood diarrhoea; covariates included access to Western medicine and education, economic conditions, engagement with the modern state and family relations. Cluster-adjusted analysis relied on the Mantel-Haenszel procedure and Mantel extension. RESULTS 24.1% (1371/5686) of women reported using traditional medicine at childbirth; these women had less education, accessed antenatal care less, experienced more family violence and were less likely to have birth certificates for their children. 11.3% (615/5425) of young children with diarrhoea were taken to traditional medical practitioners; these children were less likely to receive BCG, to have birth certificates, to live in households with a more educated head, or to use fuel other than charcoal for cooking. Education showed a gradient with decreasing use of traditional medicine for childbirth (χ(2) 135.2) and for childhood diarrhoea (χ(2) 77.2). CONCLUSIONS Use of traditional medicine is associated with several factors related to cultural transition and to health status, with formal education playing a prominent role. Any assessment of the effectiveness of traditional medicine should anticipate confounding by these factors, which are widely recognised to affect health in their own right.
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Affiliation(s)
- Iván Sarmiento
- Centro de Estudios Médicos Interculturales (CEMI), Cota, Cundinamarca, Colombia
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Germán Zuluaga
- Centro de Estudios Médicos Interculturales (CEMI), Cota, Cundinamarca, Colombia
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Neil Andersson
- CIET/PRAM, Department of Family Medicine, McGill University, Montreal, Québec, Canada
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Sahoo J, Singh SV, Gupta VK, Garg S, Kishore J. Do socio-demographic factors still predict the choice of place of delivery: A cross-sectional study in rural North India. J Epidemiol Glob Health 2015; 5:S27-34. [PMID: 26073573 PMCID: PMC7325830 DOI: 10.1016/j.jegh.2015.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 05/01/2015] [Accepted: 05/10/2015] [Indexed: 11/23/2022] Open
Abstract
Improving maternal health is one of the goals to be achieved under the Millennium Development Goal (MDG), especially MDG-5. One of the predictors of maternal health is place of child birth. This study was carried out to determine the prevalence of home delivery and different socio-demographic factors associated with them. This study was a community-based cross-sectional study. Women who delivered a baby in the past 1 year were included in this study. A total of 300 women responded (93.2%) and gave consent to participate in the study. Prevalence of home delivery was 37.7%. Bivariate analysis showed that religion, caste, education of women and their partners, occupation of the spouse, monthly family income and socioeconomic status had a significant association with the choice of place of delivery. But multivariate regression analysis showed only religion, caste, education of spouse and monthly income to be significant factors in determining place of delivery. The findings of this study suggest that individual countries have to formulate interventions which will target marginalized or vulnerable populations with reference to caste, religion and wealth. A significant improvement in reaching the 5th MDG can be achieved if the first three MDG goals are focused on, i.e., eradication of poverty, achieving universal education and women empowerment.
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Affiliation(s)
- Jyotiranjan Sahoo
- Department of Community Medicine, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi 110002, India.
| | - Satya Vir Singh
- Department of Community Medicine, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi 110002, India
| | - Vimal Kishore Gupta
- Department of Community Medicine, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi 110002, India
| | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi 110002, India
| | - Jugal Kishore
- Department of Community Medicine, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi 110002, India
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